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Have Misophonia? The Problem Is Misophonia

Fri Nov 6, 2015

A few weeks ago, the Wall Street Journal published a piece by Elizabeth Bernstein that didn’t go over very well with the misophonia community. I have been asked for my thoughts on this article by a few friends, and now that I’ve had a few weeks to gather them, I think I finally have something useful to contribute.

The Journal piece was based largely on a recent study published in the Journal of Clinical Psychology that looked at the severity of reactions to common trigger sounds of a 483 member sample of undergraduate students, and measured the percentage of the sample group that showed significant reactions.

Before I continue, I want to sincerely extend my gratitude to both Monica Wu, the co-authors of her paper, and to Elizabeth Bernstein for shedding more light on what it’s like to live with this condition. Misophonia is a newly realized phenomena, and while there has been a lot of media coverage about it, there is still a great deal of research needed to understand it, let alone develop actual methods of treatment.

Now, onto the gritty stuff.

The title of the piece: “Annoyed by Loud Chewing? The Problem Is You,” was clearly designed to provoke, but a good part of the negative reaction to the article was outrage over the suggested exposure therapy treatment—something that wasn’t included in the abstract of the study, but a subject Ms. Wu has published other papers on. This treatment is understandably not very popular with Misophonia sufferers, but I’m inclined to think Monica Wu knows what she’s talking about.

Most sufferers will tell you that their entire existence is one long exposure therapy session that never ends. Fuck, I would tell you that. Realistically, though, I doubt this is the way controlled exposure and response prevention therapy works in real life. But the article offers plenty of jabs like this:

If a loved one’s lip smacking bothers you, you need to learn to cope, therapists say; Don’t try to change a chewer.

Learn to cope? Well, no fucking shit. Learning to cope is the cure we are all hoping for.

What we have here is a simple lack of understanding by the author, the misophonia community, and possibly a failure to communicate from the researchers behind the paper. Unless you experience this condition first hand, it simply must be hard to relate. Let’s attempt to put the sensational tone of the article aside and tease out some mutual understanding.

Most media coverage of misophonia includes this tidbit from the first sentence of its Wikipedia entry:

Misophonia, literally “hatred of sound”…

Literally, yes. That is what that word means. The condition, however, is not the hatred of sound. It is an irrational emotional over response to sound stimuli. The feeling induced by the trigger sound can be described as hate or rage, but that feeling is far beyond what one would describe as a common feeling of hatred.

The fight or flight rage one experiences when triggered is closer to the emotional reaction one might experience when being punched in the gut, or slapped in the face (for me it’s frequently more severe than this, but I haven’t experienced assault more serious than being punched or slapped to make a closer comparison). It’s not a feeling that is very easy to control without serious conditioning. This feeling—this reaction is the condition. The sound is merely the trigger.

Telling someone who regularly deals with this level of stress and rage to learn to cope is a lot like telling someone who is on fire to try to not be on fire anymore. I don’t mean to make light of people who have actually suffered burn injuries, but this illustrates why so many of us were offended by the premise of this article. It feels like the entire waking period of our days are spent coping. You don’t realize how much time the people around you spend eating until that is all you can hear.

When someone with misophonia lashes out by asking you to not chew so loud or by simply leaving the room, you are witnessing an immense amount of self control. This is not “trying to change a chewer,” this is a desparate attempt at escape. We know the problem is us. Decade after decade of destroying relationships, loosing jobs, alienation from our families, and especially—especially—the unrelenting frequency of extreme stress and rage reminds us every day that we need to learn to cope.

The problem is learning how to cope. I know a handful of people that have had some success with exposure therapy. Ms. Wu was quoted in the article saying as much, but these remarks are overshadowed by statements like this:

Don’t run away. You should avoid “temporary Band-Aids,” says Ms. Wu, of the University of South Florida. If you always put on headphones or move to another room, you aren’t fully participating in the relationship. The idea is to learn to tolerate the symptoms.

Ham-fisted statements like this, and the blunt tone used to communicate the research portion of the article is what I think caused the misophonia community to reject the idea of exposure treatment, and take general offense to the article as a whole.

Clearly there is an effective way to pursue exposure treatment, but with the small amount of available research on misophonia and ignorance of the condition by most medical practitioners (not to mention insurance companies), pursuing effective treatment is very difficult. Simply avoiding “temporary Band-Aids” is not effective treatment.

We know because we have been regularly exposed to these sounds for most of our lives (33 years for me), yet the symptoms worsen rather than improve. While we do frequently resort to headphones, ear plugs, and storming out of the room, there are many times every day where none of these things are possible and we simply must endure. Spend a few minutes on /r/misophonia and you will see there is no shortage of exposure to trigger sounds amongst sufferers.

Instead of telling us to stop having our problem, help us learn how to stop having it. Then maybe we can stop bringing up your eating habits.